Organization
GRACE HEALING AND WELLNESS CENTER, LLC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANGELIQUE LEWIS PHD (PSYCHOLOGIST)
(414) 350-6693
Entity
Organization
Contact information
Practice address
N28W23000 ROUNDY DR STE 105, PEWAUKEE, WI 53072-7300
(414) 350-6693
Mailing address
N28W23000 ROUNDY DR STE 105, PEWAUKEE, WI 53072-7300
(414) 350-6693
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100003219
—
WI
Enumeration date
05/26/2022
Last updated
05/26/2022
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